孕前体质指数、妊娠期糖尿病及孕期增重对新生儿出生结局和分娩方式的影响  

Impacts of pre-pregnancy body mass index,gestational diabetes mellitus and gestational weight gain on perinatal outcomes and mode of delivery

作　　者：吕岩玉[1] 富冬梅[2] 王贺茹[3] 王晓颖[4] 修青永 王晓宏[2] 崔小岱[1] 米荣[4] 李莉[4] Lyu Yanyu;Fu Dongmei;Wang Heru;Wang Xiaoying;Xiu Qingyong;Wang Xiaohong;Cui Xiaodai;Mi Rong;Li Li(Central Laboratory,Capital Institute of Pediatrics,Beijing 100020,China;Department of Obstetrics,Beijing Daxing Maternal and Child Care Hospital,Beijing 102699,China;Department of Child Health Care,Children's Hospital Affiliated to the Capital Institute of Pediatrics,Beijing 100020,China;Department of Neonatology,Children's Hospital Affiliated to the Capital Institute of Pediatrics,Beijing 100020,China;Department of Pediatrics,Beijing Daxing Maternal and Child Care Hospital,Beijing 102699,China)

机构地区：[1]首都儿科研究所实验中心,北京100020 [2]北京市大兴区妇幼保健院孕产保健部,北京102699 [3]首都儿科研究所附属儿童医院儿童保健科,北京100020 [4]首都儿科研究所附属儿童医院新生儿科,北京100020 [5]北京市大兴区妇幼保健院儿科,北京102699

出　　处：《中华新生儿科杂志（中英文）》2023年第7期412-418,共7页Chinese Journal of Neonatology

基　　金：首都儿科研究所方向性引导基金(FX-15-04)。

摘　　要：目的探讨母亲孕前体质指数(body mass index,BMI)、妊娠期糖尿病(gestational diabetes mellitus,GDM)和孕期增重对新生儿出生结局和分娩方式的影响。方法基于前瞻性队列研究设计,募集2016年11月至2017年12月在北京市大兴区妇幼保健院产检的孕早期(<13周)单胎孕妇并随访至分娩。根据孕前BMI分为肥胖、超重、正常和体重不足4组,根据孕24~28周口服75 g葡萄糖耐量试验结果分为GDM组和非GDM组,根据孕期增重情况分为过度、适宜和不足3组。应用多项logistic回归模型评估孕前BMI、GDM和孕期增重对巨大儿和低出生体重儿的影响,应用多因素非条件logistic回归模型评估孕前BMI、GDM和孕期增重对分娩方式及早产的影响。结果共纳入802例孕妇,孕前超重率21.8%,孕前肥胖率8.9%;GDM发生率14.1%;孕期增重过度占57.2%。巨大儿发生率7.1%,低出生体重儿发生率2.7%,早产发生率2.2%,剖宫产率37.7%。孕前肥胖(AOR=4.355,95%CI 1.900~9.980)和孕期增重过度(AOR=3.799,95%CI 1.796~8.034)是巨大儿的独立危险因素;孕期增重过度是低出生体重儿(AOR=0.279,95%CI 0.084~0.928)的保护因素;孕期增重不足是低出生体重儿(AOR=10.954,95%CI 3.594~33.382)和早产(AOR=8.796,95%CI 2.628~29.438)的危险因素。与孕前体重正常的孕妇相比,孕前超重孕妇剖宫产风险增加(AOR=1.817,95%CI 1.119~2.949);与无孕前超重/肥胖、GDM和孕期增重过度的孕妇相比,孕前超重/肥胖、GDM和孕期增重过度三者中任何两者联合暴露均增加了巨大儿(AOR=3.908,95%CI 1.630~9.370)和剖宫产(AOR=2.269,95%CI 1.325~3.886)风险,且三者联合暴露时巨大儿和剖宫产风险最高。结论孕前肥胖和孕期增重过度是巨大儿的独立危险因素,孕前超重使孕妇剖宫产风险增加。孕前超重/肥胖、GDM和孕期增重过度三者中任何两者联合暴露均使巨大儿和剖宫产风险增加,三者联合暴露时巨大儿和剖宫产风险最高。Objective To study the impacts of pre-pregnancy body mass index(BMI),gestational diabetes mellitus(GDM)and gestational weight gain(GWG)on perinatal outcomes and mode of delivery.Methods From November 2016 to December 2017,single-pregnancy women in early pregnancy(<13 weeks)regularly checked-up at our hospital were enrolled in this prospective cohort study and followed up until delivery.They were assigned into four groups according to pre-pregnancy BMI:obese group(≥28.0 kg/m2),overweight group(24.0-<28.0 kg/m^(2)),normal group(18.5-<24.0 kg/m^(2))and underweight group(<18.5 kg/m^(2)).A 75-g oral glucose tolerance test was performed at 24-28 weeks of pregnancy to screen for GDM.The optimal GWG was 11.0-16.0 kg for underweight group,8.0-14.0 kg for normal group,7.0-11.0 kg for overweight group and 5.0-9.0 kg for obesity group.The effects of pre-pregnancy BMI,GDM and GWG on perinatal outcomes and delivery mode were evaluated using multivariate logistic regression methods.Results A total of 802 pregnant women were included.The incidences of pre-pregnancy overweight and obesity were 21.8% and 8.9%,respectively.The incidence of GDM was 14.1%.57.2% of the participants experienced excessive GWG.The incidences of macrosomia,low birth weight and premature birth were 7.1%,2.7%and 2.2%,respectively.The incidence of Cesarean delivery(C-section)was 37.7%.Pre-pregnancy obesity[adjusted odds ratio(AOR)=4.355,95%confidence interval(CI)1.900-9.980]and excessive GWG(AOR=3.799,95%CI 1.796-8.034)were independent risk factors for macrosomia.Excessive GWG was a protective factor for low birth weight(AOR=0.279,95%CI 0.084-0.928)and inadequate GWG was a risk factor for low birth weight(AOR=10.954,95%CI 3.594-33.382)and premature birth(AOR=8.796,95%CI 2.628-29.438).Compared with the normal group,overweight group had an increased risk of C-section(AOR=1.817,95%CI 1.119-2.949).Compared with pregnant women without pre-pregnancy overweight/obesity,GDM nor excessive GWG,any combination of two of the above-mentioned three factors increased the

关 键 词：孕前体质指数 妊娠期糖尿病 孕期增重 巨大儿 剖宫产 

分 类 号：R715.3[医药卫生—妇产科学]